Microsoft Word - DECEASE CLAIM SET.doc

SBI DOC BY 4577825

SETTLEMENT OF DECEASED’S ASSETS WITHOUT LEGAL REPRESENTATION/NOMINATION

DETAIL OF CLAIMANTS / DOCUMENTS SUBMITTED

NAME OF DECEASED : ____________________________________________________

DATE & PLACE OF DEATH : ___/___/20___ & _____________________________

ACCOUNT(S) NO : ____________________________________________________

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NAME OF CLAIMANT(S) : ____________________________________________________

ADDRESS WITH PHONE NO : ____________________________________________________

____________________ MOB /PH NO: ____________________

____________________________________________________

(Signature of All Claimants)

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DOCUMENTS TO BE SUBMITTED

DEATH CERTIFICATE OF DECEASED

PASSBOOK / ATM CARD / UNUSED CHEQUE LEAVES / STDR RECEIPT (In Original)

IDENTITY CARD OF ALL CLAIMANT(S) (Showing Relationship with the Deceased)

ADDRESS PROOF OF ALL CLAIMANT(S)

FAMILY MEMBERSHIP / LEGAL HEIRSHIP CERTIFICATE (Issued by A competent Authority)

STAMPED LETTER OF INDEMNITY

STAMPED AFFIDAVIT (To be Notarized / Authorized by Magistrate)*

STAMPED LETTER OF DISCLAIMER (To be Notarized / Authorized by Magistrate)

STAMPED LETTER OF RELINQUISHMENT (IF REQUIRED) (To be Notarized / Authorized by Magistrate)

I D CARD & ADDRESS PROOF OF SURETY(ies) (Required if Claim Amount More than 50000/-) $

ASSETS / LIABILITIES DOCUMENTS WITH INCOME PROOF OF SURETY(ies) @

REVENUE STAMP OF 1/-

STAMP PAPER OF _______/- FOR LETTER OF INDEMNITY (In the Name of Claimants)

STAMP PAPER OF _______/- FOR LETTER OF DISCLAIMER (In the Name of Disclaimers)

STAMP PAPER OF _______/- FOR AFFIDAVIT (In the Name of Deponent)

ANY OTHER DOCUMENT: ______________________________________________________________

* Affidavit to be submitted by a person knowing the Deceased & All family members.

$ Surety must not be related / directly involved in Assets of the Deceased.

@ Surety Net-worth must be at least Double the Claim Amount (2 Sureties may be taken)

Note: All Documents must be presented in original for verification.

Paste Photograph of All

Claimants

SBI DOC BY 4577825

FORM-I

SETTLEMENT OF DECEASED’S ASSETS WITHOUT PRODUCTION OF

LEGAL REPRESENTATION UNDER DISCRETIONARY POWERS

CLAIM FORMAT

To Address for Correspondence

Chief / Branch Manager Shri/Smt _____________________

State Bank of India _____________________________

___________________ _____________________________

___________________ Mobile/Ph: ____________________

Date: ____/____/20_____

Dear Sir / Madam

CLAIM FOR PAYMENT OF BALANCES IN THE ACCOUNT(S) OF

LATE SHRI/ SMT/ KUM _______________________ EXPIRED ON ___/___/20__

I/We advise that Shri/ Smt/ Kum. _______________________________ expired on ___/___/20___

/ is not traceable since ___/___/20___

2. Late Shri/ Smt/ Kum __________________________ was maintaining a Saving Bank/ Current

Account/ RD Account/ TDR/ STDR/ etc._________________________ in your Branch as follows.

NATURE OF

DEPOSIT (SB

/CA/TDR/RD)

A/C NO

AMOUNT

DATE OF

MATURITY

(In case of TD)

Nature of

Liability to the

Bank (if Any)

AMOUNT

TOTAL DEPOSIT AMOUNT TOTAL OF BANK LIABILITY

** (The actual amount of claim with accrued interest will be worked out on the date of payment.)

Note: For Additional no of Accounts attached separate Sheet.

3. I/We lodge my/our claim for the above balances with accrued interest of the above named

deceased in terms of:

a. * Will of the Late Shri / Smt / Kum _________________________ Dated ___/___/_____

and a probate granted by the Court of _________________ at ________________ dated

___/___/_______ (Copies enclosed).

b. * Succession Certificate dated ___/___/______ granted by the Court of ______________ at

___________________ (Copy Enclosed).

SBI DOC BY 4577825

c. Letter of Administrator No ____________ dated ___/___/_______ Issued by _________ at

_________________ (Copy Enclosed).

d. The deceased died intestate. I/We lodge my/our claim without a legal representation for

payment as per the Bank’s rules & discretion.

(* Strike out if not applicable)

4. We furnish below the required information about the deceased & the legal heirs in this regard.

a. Date & Place of Death : ___/___/20____ & _______________________ (Place)

b. Details of Death Certificate : Death Certificate No __________ Dated ___/___/20____

Issuing Authority ________________________________

(Original to be produced for verification)

c. Permanent Address of the Deceased : ____________________________________________

__________________________________________________________________________

d. Religion: ___________________________________ (Hindu / Muslim / Sikh / Christen etc.)

e. Which Law of Succession is Applicable? : ________________________ (Hindu / Muslim etc.)

f. Names in full of the parents of the Deceased:

Father: ______________________________ Mother: _______________________________

g. If parents(s) are living, their Ages: 1) Father ______ Years 2) Mother ______ Years.

h. Name in full of the widow / widower of the Deceased Smt/ Shri ________________________

Age, (if living) ______ Years.

i. Name (s) & age (s) of the living children of the Deceased:

i. ___________________________ Age _______ Years

ii. ___________________________ Age _______ Years

iii. ___________________________ Age _______ Years

iv. ___________________________ Age _______ Years

v. ___________________________ Age _______ Years

j. Name(s) & age (s) of the living Grand Children of the Deceased:

(Children of only predeceased Son or Daughter)

i. ___________________________ Age _______ Years

ii. ___________________________ Age _______ Years

iii. ___________________________ Age _______ Years

iv. ___________________________ Age _______ Years

v. ___________________________ Age _______ Years

k. Name (s) & age of living Brothers of the Deceased:

i. ___________________________ Age _______ Years

ii. ___________________________ Age _______ Years

iii. ___________________________ Age _______ Years

SBI DOC BY 4577825

l. Name (s) & age of the living Sisters of the Deceased:

i. ___________________________ Age _______ Years

ii. ___________________________ Age _______ Years

iii. ___________________________ Age _______ Years

m. Name (s) of the minor(s) & Natural Guardian (s) Legal Guardian (s) of minors amongst the

Claimants. (If Legal Guardian is appointed, a copy of the order must be enclosed)

Name (s) of the Minor Claimant(s):

i. ___________________________ Age _______ Years

ii. ___________________________ Age _______ Years

iii. ___________________________ Age _______ Years

Name (s) of the Guardian (s) Relationship with the Minor Claimant (s) above:

i. ___________________________ Age _______ Years

ii. ___________________________ Age _______ Years

iii. ___________________________ Age _______ Years

n. Shri/ Smt/ Kum _________________________________________ i.e the person furnishing

the declaration below /the affidavit (Annexure ‘B’) knows our family for the last ____ Years &

is not related with our family.

o. * Name and ages of the Claimants who propose to execute the Letter of Disclaimer.

i. ___________________________ Age _______ Years

ii. ___________________________ Age _______ Years

iii. ___________________________ Age _______ Years

iv. ___________________________ Age _______ Years

v. ___________________________ Age _______ Years

vi. ___________________________ Age _______ Years

p. A Letter of Disclaimer duly stamped & executed is enclosed (* Strike out if not applicable)

q. We propose the following Surety(ies) - (No surety required for amounts up to Rs.50,000/-)

a. Name & Address: Shri./Smt/ Kum _________________________________________

_____________________________________________________________________

b. Name & Address: Shri./Smt/ Kum _________________________________________

_____________________________________________________________________

(The detailed information on the sureties, to arrive at their worth, is to be furnished in separate

form. Sureties, who are the relatives of the deceased, may be accepted, provided they are not

directly involved as claimants and are considered individually or jointly good for the amount

involved. If one surety is considered good for the amount by the Bank, second surety is not

necessary. The sureties have to sign the Letter of indemnity as per format enclosed (COS 540). The

Letter of indemnity will be stamped according to the Stamp Act in force in the respective State)

SBI DOC BY 4577825

I / We declare that the facts stated above are true and correct to the best of my / our knowledge

and belief.

Signature(S) of the Claimant (S) Who Will Receive the Amount.

I) ______________________________

II) ______________________________

III) ______________________________

IV) ______________________________

V) ______________________________

Place: ________________ Date: ____/____/20____

(To be signed by all the claimants other than those who have relinquished their right in the property

by furnishing a “Letter of Disclaimer” as per the format enclosed and will be stamped according to

the Stamp Act in force in the respective State)

(Please note that the claimants will have to sign the receipt for having received the claim amount)

Encl: As above

(Note: The Bank is not responsible for any delay in deposit of the claim due to lack of full particulars

furnished in this application and may insist on calling for a Legal Representation in case there are

disputes among legal heirs& all of them do not join in indemnify the Bank (Or give letter of

disclaimer) or where the Bank has reasonable doubt about the genuineness of the claimants (s)

being the only heir(s) of the deceased customer)

SBI DOC BY 4577825

DISPOSAL OF DECEASED’S ASSETS WITHOUT PRODUCTION

OF LEGAL REPRESENTATION UNDER DISCRETIONARY POWERS

FOR OFFICE USE

Report of the Recommending Authority:-

I have made necessary inquiries about the claim made by the claimants and satisfied. I recommend

that the claim may be settled.

o The sureties are waived (Amounts up to 50,000)*

o Surety (ies) offered are acceptable as per Bank’s extant instructions.*

o All the necessary documents have been obtained. The claim may be paid to the claimants.

*(Strike out if not applicable)

Any other Remarks:

________________________________________________________________________________

Place : _____________

Date : ___/___/20___ Signature with Date Name & Designation

(Recommending Authority)

Sanctioned& Control Return sent on ___/___/20____

Place : _____________

Date : ___/___/20___ Signature with Date Name & Designation

(Sanctioning Authority)

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DISBURSEMENT & RECORD

Amount paid by Banker’s Cheque No _______________ dated ___/___/20____ for __________

(Rupees ________________________________________________________________________)

Documents kept in Branch Documents vide item No ________ page No ______

Place : _____________

Date : ___/___/20___ Signature with Date Name & Designation

(Branch Manager / Manager Operation)

Note: Where the Recommending Authority & Sanctioning Authority is same, he should sign in both

the capacities)

SBI DOC BY 4577825

FORM-II (COS 540)

(To be duty stamped as per the Stamp Act applicable to the State)

LETTER OF INDEMNITY

(Letter of indemnity with respect to payment of Balance in the Deceased Constituent’s

Account without production of Legal Representation)

To,

Chief / Branch Manager

State Bank of India

_____________________

IN CONSIDERATION of your paying or agreeing to pay us,

1. ___________________________________________________

2. ___________________________________________________

3. ___________________________________________________

4. ___________________________________________________

5. ___________________________________________________

6. ___________________________________________________

The sum of Rupees____________________________________________________ standing at the

credit of Savings Bank/ Current/ R.D Account No. etc. _____________ with your Bank/Branch in the

name of Shri/ Smt/ Kum _________________________________ since deceased, without

production of Letters of Administration or a Succession Certificate to his/ her estate or a Certificate

from the Controller of Estate Duly to the effect that estate duly has been paid or will be paid or none

is due, we

1. ___________________________________________________

2. ___________________________________________________

do hereby for ourselves and our heirs, legal representative executors and administration, jointly and

severally UNDERTAKE AND AGREE TO INDEMNIFY you and successors and assign against all claims,

demands, proceedings, losses, damages, charges and expenses with may be raised against or

incurred by you by reason or in consequence of your having agreed to pay/ or paying me/ us the

said sum as aforesaid.

Signed, Sealed and delivered by the above named on

This ______ Day of ________ Two Thousand _____________________________

SIGNED AND DELIVERD by The above named

1._________________________ 2._________________________ 3.________________________

4._________________________ 5._________________________ 6.________________________

(Heirs / Claimants of the Deceased)

Name(s) of All

the Claimant(s)

to Be Written

Here

Insert here the

Name(s) of the

Surety (ies)

SBI DOC BY 4577825

SIGNED AND DELIVERED by The above named

1. ___________________________________ 2. _____________________________________

(Sureties)

NOTE

1. A Letter of indemnity on from COS 540 is to be stamped as an agreement. A letter of indemnity

need not ordinary be attested provided the executants attends the Bank personally or his

signature is on record with the Bank. It will have to be stamped as an Indemnity Bond if attested

by a witness.

2. Where the executants/ signatories of the documents are resident in different places/ states the

under noted guidelines advised by Law Department should be followed. “The section 17 of the

Indian Stamp Act, 1899 provides that all instruments chargeable to the duty and executed by

any person in India shall be stamped before or at the time on execution.

“Execution” in means “Signature” The chargeable event is the execution of the instrument.

Section 19 A added locally in various States provides for payment of difference in duty, if any, in

accordance with the rates in force in those States. In other words, in such case, the instruments

to be executed may be stamped according to the applicable laws of the first person signing the

documents and if the rate of duty payable in the another State where the executants resides is

higher, the instrument may be further stamped (Adhesive Stamps) with the difference in duty.

However, if the rate is same or lower, it will not be required to be further stamped. In the

alternative, the instrument may be stamped with the highest duty chargeable on the instrument

at the time of execution by the first signatory of the instrument/ document”.

SBI DOC BY 4577825

FORM- III

LETTER OF DISCLAIMER

(To be duly stamped as per the Stamp Act applicable to the State)

To,

Chief / Branch Manager

State Bank of India

_____________________

Dear Sir / Madam,

______________*Account No ____________________________

In the Name of Late Shri/ Smt/ Kum_______________________

Balance ________________

With reference to the above account(s), I/ We, the following legal heirs of the late Shri/ Smt/Kum.

_______________________________ (Name of the Deceased account holder) have to advise that

we have no interest in the above assets and as such we have no objection to your paying the

balance amount lying in the above account(s) with you in the name of the aforesaid Shri/ Smt/ Kum

________________________________ (Name of the deceased) to Shri/ Smt/ Kum:

1. ___________________________________ Relationship with Deceased ___________________

2. ___________________________________ Relationship with Deceased ___________________

3. ___________________________________ Relationship with Deceased ___________________

4. ___________________________________ Relationship with Deceased ___________________

5. ___________________________________ Relationship with Deceased ___________________

Such delivery of the payment of the balance in the above account(s) would be completely binding to

us and we will not question the Bank’s action in so doing if any proceedings. I/ We undertake to bind

ourselves, our heirs and legal representative not to revoke the declaration made herein.

Sr.No. Name(s) of the Disclaimer(s) Age Signature

1. _____________________________ ___ Years _______________________

2. _____________________________ ___ Years _______________________

3. _____________________________ ___ Years _______________________

4. _____________________________ ___ Years _______________________

5. _____________________________ ___ Years _______________________

6. _____________________________ ___ Years _______________________

7. _____________________________ ___ Years _______________________

8. _____________________________ ___ Years _______________________

Signed before me this _________ Day of _____________ 20____

Seal (Notary Public / Magistrate)

*Fill in here the type of Account viz. SB/ RD/ Term Deposit/ Current Account etc.

SBI DOC BY 4577825

FORM- IV

LETTER OF RELINQUISHMENT

(To be stamped as per the Stamp Act applicable in the State)

To,

Chief / Branch Manager

State Bank of India Date : ___/___/20___

_____________________

Dear Sir / Madam,

Current /Savings Bank Account No __________________ for _____________ AND /OR

T.D.R No _________________ Dated __/__/20__ for _______Due on ___/___/20___

In the name of Late _____________________________________ (Deceased)

With reference to the above Current Account/ Savings Bank Account/ TDR Account I

_______________________________________________ (Name and relationship to the Deceased)

of Late Shri/Smt/Kum _______________________________(name of the deceased) have to advise

that I have no interest in the assets of ____________________________(name of the deceased)

and as such, I have no objection so your paying the balance lying in the Current / Savings Bank /

TDR Account in the name of the aforesaid, Late Shri/Smt/Kum ______________________________

(insert here name of the deceased) to Shri/ Smt _________________________________________

Such delivery of the ornaments and/ or payment of the balance in the Current / Savings Bank / TDR

Account would be completely binding on me and I will not question the Bank’s action in so doing, in

any proceedings. I also undertake to bund myself, my heirs and legal representations not to revoke

the declarations made herein Witness.

Yours faith fully

(Signature of the party)

Signature Verified

BRANCH MANAGER

SBI DOC BY 4577825

FORM- V

FORM OF RECEIPT TO BE OBTAINED WHILE DISPOSAL OF

ASSETS / DEPOSITS BALANCE OF THE DECEASED

Received from STATE BANK OF INDIA _____________________________ Branch a sum of

__________/- (Rupees________________________________________________ only)

vide Banker’s Cheque No ______________ dated ___/___/20___ being the proceeds of

the deposit/s standing in the name of Late Shri / Smt/Kum _________________________

As detailed below together with interest accrued thereon up to date in full and final

settlement of all the claims made by me/us.

Sl.No Name of the A/c A/c No Amount in Rs.

1. __________________ ____________________ _________________

2. __________________ ____________________ _________________

3. __________________ ____________________ _________________

4. __________________ ____________________ _________________

5. __________________ ____________________ _________________

6. __________________ ____________________ _________________

7. __________________ ____________________ _________________

8. __________________ ____________________ _________________

9. __________________ ____________________ _________________

10. __________________ ____________________ _________________

Place : _____________

Date : ___/___/20___

(SIGNATURE OF ALL CLAIMANTS)

Re.1/

Revenue

Stamp

SBI DOC BY 4577825

FORM - VI (COS 539)

AFFIDAVIT

(To be duly stamped as per the Stamp Act applicable to the State)

I/We (1) _________________________ Son/Wife of _______________________ Residing at ____

______________________________________________________ and (2) ___________________

_________ Son / Wife of ________________________ Residing at ________________________

_______________________________________ Do hereby make oath * / Solemnly affirm and say

as follows:

1. That Late Shri/ Smt/ Kum _________________________ (Name of the Deceased) (hereinafter

referred to as “the deceased”) died intestate on ____/____/20_____

2. That I/We know the deceased and his family since the last _____ Years

3. That at the time of his/her death the deceased left surviving him/her the following persons who

according to the law by which they are governed, are the only legal heirs of the deceased

entitled to succeed to the estate of the deceased on an interstate on an interstate succession;

Sr.No. Name(s) of the Member(s) Age Relationship with Deceased

i. _____________________________ ____ Years _______________________

ii. _____________________________ ____ Years _______________________

iii. _____________________________ ____ Years _______________________

iv. _____________________________ ____ Years _______________________

v. _____________________________ ____ Years _______________________

vi. _____________________________ ____ Years _______________________

vii. _____________________________ ____ Years _______________________

viii. _____________________________ ____ Years _______________________

4. That we are not related in any manner whatsoever to the deceased or any of the above

mentioned persons nor have we any claim or interstate of whatsoever nature in the estate of the

deceased.

5. That we are informed and we verily believe that the deceased has left certain deposits/ assets

with the State Bank of India _______________ Branch, to which the abovementioned persons

are entitled to claim.

6. That we are making this solemn declaration sincerely and conscientiously believing the same to

true and with full knowledge that it is on the strength of this declaration that the State Bank of

India _______________ Branch, has agreed at our request to make payment of the amounts of

the deposit/ to deliver the assets to the abovementioned persons without insisting on produced

by them of a grant of legal representation to the estate of the deceased from a competent Court.

Sworn * / solemnly affirmed

1) ____________________________________ 2) ___________________________________

At this ________ Day of ____________, 20____ in the Presence of _________________Before me

NOTARY / MAGISTRATE

SBI DOC BY 4577825

________________________

To,

Asstt. General Manager

State Bank of India

________________________

DISPOSAL OF DECEASED’S ASSETS WITHOUT PRODUCTION OF LEGAL REPRESENTATION

UNDER BRANCH MANAGER DISCRETIONARY POWERS

1. Name of Deceased Late

2. Date of Death

____/___/20_____

Whether Death Certificate has

been registered in Bank’s Book

Whether the Deceased Died

Testate / Intestate

5. Segment of the Account(s) /Assets

6. PARTICULAR OF DEPOSITS / ASSETS:

(a) Type of Deposits (SB/CA/TDR)

(b) Total Amount Involved

(c)

Whether the Unused Chq Leaves

/ATM Card have been taken back

Whether Deceased had any Bank

Liabilities (Give Details)

Whether the above Liabilities have

been settled before disposal of the

Assets of deceased

Name of the Claimants/ Legal

Heirs, and Relationship with the

Deceased

1. _______________________ Relation ____________

2. _______________________ Relation ____________

3. _______________________ Relation ____________

4. _______________________ Relation ____________

5. _______________________ Relation ____________

6. _______________________ Relation ____________

7. _______________________ Relation ____________

8. _______________________ Relation ____________

9. _______________________ Relation ____________

10. _______________________ Relation ____________

10.

In Case of any Minor, they have

been represented by

11.

Whether Assets from part of the

self acquired Assets of deceased.

SBI DOC BY 4577825

12.

Whether satisfied by independent

enquiries as to the correctness of

the particulars furnished by the

claimants

13.

Names of the Claimants in whose

name Claim was Settled

14. Date of Settlement / Disposal

____/___/20_____

15. Documents Taken

[ ] STANDARD CLAIM FORMAT

[ ] DEATH CERTIFICATE OF DECEASED

[ ] PASSBOOK/ ATM CARD / UNUSED CHEQUE LEAVES / STDR RECEIPT

[ ] IDENTITY CARD OF ALL CLAIMANT(S) (Showing Relationship)

[ ] ADDRESS PROOF OF ALL CLAIMANT(S)

[ ] FAMILY MEMBERSHIP / LEGAL HEIRSHIP CERTIFICATE

[ ] STAMPED LETTER OF INDEMNITY

[ ] STAMPED AFFIDAVIT (Notarized / Authorized by Magistrate)

[ ] STAMPED LETTER OF DISCLAIMER

[ ] STAMPED LETTER OF RELINQUISHMENT

[ ] I D CARD & ADDRESS PROOF OF SURETY(ies)*

[ ] ASSETS / LIABILITIES DOC. WITH INCOME PROOF OF SURETY(ies)*

[ ] NO SURETY AS AMOUNT IS UPTO Rs.50000/-

[ ] RECEIPT FROM THE CLAIMANTS

Remarks:

________________________________________________________________________________

Please confirm my action.

For State Bank of India

Branch Manager

Date : ____/____/20____

SBI DOC BY 4577825

FORM NO - IX

OPINION REPORT ON THE SURETY

1. Name of Surety

2. Address with Phone No

3. Academic Qualification

4. Age of Surety

Occupation (If Employed Details of

Employment)

Present Monthly Income/Salary

(Attach Salary Slip in case of Salary)

7. Total Yearly Income from All Sources

8. No. of Dependent Family Members

9. DETAILS OF PERSONAL ASSETS: Description Amount

(a)

Immovable Property viz: Land/

Building, Flat etc. (Give Details)

(b)

Investment (Fixed Deposits / Shares

etc.)

(c)

Surrender Value of Life Insurance

Policies

(d) Other Assets if Any

TOTAL ASSETS (Sum of (a) to (d)

10. Personal Liability if Any

11. NETWORTH OF SURETY (9-10)

11.

Details of Bank A/c (Bank/Branch

Name, A/c No, A/c Type etc.)

12.

Whether Surety is related to the

Deceased / Claimants

[ ] Yes [ ] No

13.

Period for which Claimants are

known to Surety

Years

I confirm that all the statements made by me in this application are true and correct and have been

made by me.

Place : ______________

Date : ___/___/20____ (Signature of Surety)

Remarks: ________________________________________________________________________

________________________________________________________________________________

Divisional Manager / Branch Manager: